Registration Form
Name
*
First Name
Last Name
Email
*
example@example.com
Which Location would you like to enroll in?
*
Please Select
Mid-City LA
Irvine
Pasadena
Anaheim
San Diego
Online/Virtual
1:1 Private(In person/Virtual)
Date of Birth
*
-
Month
-
Day
Year
Date
Date
-
Month
-
Day
Year
Date
Parent(Guardian) name if attendee is under 18 years
*
First Name
Last Name
Primary Phone number(For your class WhatsApp group)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency(secondary) Contact Name
*
Emergency(secondary) Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Pronouns
*
He/She
They
Does the registrant have experience in Kathak or another dance form? If so, what type and how many years?
*
Why do you want to learn Kathak?
*
What city do you live in? So we can find the best location for you!
*
Any medical conditions or injuries that may impact your learning or performance?
*
How did you hear about us?
*
Friend
Flyer
Other
Friend's name
*
Would you like to subscribe to Nrityanvita Kathak Academy newsletter?
*
I want to
I don't want to
*
I understand that I must sign and return the liability waivers and class guidelines forms prior to beginning class
Please notify Anvita Sharma when you've completed this form for more instructions at (626) 808-6448.
*
I acknowledge
age
location
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